Decompressive Craniectomy in Postpartum Cortical venous Thrombosis Masquerading as Postspinal Headache

Neelam Suri, Vinit Suri, K. Suri
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Abstract

Cerebral venous sinus thrombosis is commonly seen during pregnancy or in the postpartum period due to multiple physiological changes resulting in an altered state of homeostasis and a hypercoagulable state. Cortical vein thrombosis is a subgroup of cerebral venous thrombosis where there is an involvement of the superficial cerebral veins and may occur with or without coexisting sinus venous thrombosis. Early identification of the diagnosis is of utmost importance to reduce morbidity and mortality. Differentiation from postspinal headache may be difficult until the occurrence of neurological features and a high level of suspicion for this condition is required. Contrast magnetic resonance imaging venography or computed tomography venography can confirm the diagnosis. We report a case of postpartum cortical venous thrombosis with malignant cerebral sinus venous thrombosis (CSVT). The patient was managed with a lifesaving decompressive craniectomy (DC) procedure and anticoagulants with a favorable response. Obstetricians should be aware of this medical complication of pregnancy and of its management. Medical treatment with anticoagulants is the mainstay of therapy. Patients with malignant CSVT presenting with rapid and severe neurological decline carry a high mortality, and early DC in this subgroup can be lifesaving. Contraceptive agents containing estrogens should not be administered in patients with a previous history of CSVT, and prophylactic low-molecular-weight heparin should be administered throughout a subsequent pregnancy and continued into the puerperium.
产后皮质静脉血栓形成伪装为脊柱后头痛的减压颅骨切除术
脑静脉窦血栓形成常见于妊娠期或产后,是由于多种生理变化导致体内平衡状态改变和高凝状态所致。皮质静脉血栓形成是脑静脉血栓形成的一个亚群,它累及脑浅静脉,可伴有或不伴有窦静脉血栓形成。早期诊断对降低发病率和死亡率至关重要。在出现神经学特征和高度怀疑之前,与脊髓后性头痛的鉴别可能是困难的。对比磁共振血管造影或计算机断层血管造影可确诊。我们报告一例产后皮质静脉血栓形成合并恶性脑窦静脉血栓形成(CSVT)。患者接受了挽救生命的减压颅骨切除术(DC)手术和抗凝剂治疗,反应良好。产科医生应该意识到这种医学并发症的妊娠和它的管理。抗凝药物治疗是治疗的主要手段。恶性CSVT患者表现为快速和严重的神经功能下降,死亡率高,这一亚组的早期DC可以挽救生命。既往有CSVT病史的患者不应使用含有雌激素的避孕药,预防性低分子肝素应贯穿整个妊娠并持续到产褥期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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13 weeks
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